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Abnormal Uterine Bleeding

The symptoms and causes of uterine bleeding.

What is Abnormal Uterine Bleeding

The symptoms and causes of abnormal uterine bleeding
Heavy periods, missed periods and bleeding between periods are all common signs

Many women experience an uneven menstrual cycle from time to time. For instance, girls often experience irregular periods soon after they first start having them. Women in perimenopause—the transition time before menopause - may also have irregular periods. Stress, medication and nutrition can also affect your menstrual cycle.

If you’re having more or lesser periods than once a month or heavy bleeding, this is considered abnormal or dysfunctional uterine bleeding.

What is a Regular Menstrual Cycle?

Generally, the time between the first day of a woman’s period to the first day of the next is from 21 to 35 days. The average length is three to seven days.

The duration and frequency of your period can change with age. Between the ages of 45 and 55, for example, many women are transitioning into menopause, a period known as perimenopause. If you are within that age range, and you have not had a period in 12 consecutive months, you are in menopause.

Abnormal uterine bleeding is:

  • Spotting or bleeding between periods
  • More than one period a month or fewer than one a month
  • Periods that last longer than usual
  • Heavy bleeding during your period, especially if other symptoms accompany it, such as shortness of breath or lightheadedness
  • Bleeding after menopause

What are the causes?

Heavy periods, missed periods and bleeding between periods are all common signs. There can be many causes - many of which are benign and can be corrected. Visit your health care provider for a thorough evaluation.

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Structural (physical) reasons

There might be a structural (physical) reason, such as a uterine fibroid, or a non-structural reason, such as hormones.

Structural abnormalities include:

  • Uterine fibroids, which are benign tumors of the uterus
  • Polyps in the uterus or cervix
  • Adenomyosis, a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus
  • Vaginal atrophy that leads to dryness and thinning of the vaginal wall
  • Endometrial hyperplasia, which is an abnormal thickening of the uterine lining
  • Certain types of cancer, such as cancer of the uterus or cervix
Non structural

Non-structural causes of abnormal uterine bleeding include:

  • Hormonal fluctuations
  • Problems with ovulation
  • Polycystic ovarian syndrome, a hormonal disorder that causes issues with ovulation
  • Perimenopause
  • Problems with making blood clots and other bleeding disorders
  • Thyroid disease
  • Certain medications (bleeding between periods might be a side effect of birth control pills)
  • An infection

How will my doctor determine what’s causing the bleeding?

As a rule of thumb, keep track of your menstrual cycle so that you know what’s normal for you and to provide the doctor with information if you do experience issues. Note the dates on which you have your period, the length and the heaviness of the flow on each day.

Your health care provider will take a thorough medical history that will include any past surgeries and your pregnancy history, if applicable.

Tests might include:

  • A pregnancy test.
  • Bloodwork to check your blood count and hormone levels.
  • A pelvic ultrasound to detect any physical causes.
  • An endometrial biopsy to check for abnormal cells in the uterine lining.
  • A hysteroscopy, which lets your doctor look inside the uterus with a tiny camera without making incisions.

What is the treatment?

The treatment will depend on the underlying cause. If it’s related to your hormones, for instance, your doctor may prescribe medication. If the bleeding is due to a physical problem, such as a polyp or fibroid, surgery might be indicated.

You and your doctor will choose the treatment based on the cause and whether you plan to get pregnant in the future.

Even if the cause of the bleeding might be benign, schedule an evaluation, particularly if you are in menopause.